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Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

EMR vendor athenahealth has been driving forward for a while now to build a new hospital inpatient system and fight for the big-ticket customers in acute care. Given the intense competition for the acute care EMR dollar, I’m skeptical that athenahealth can wedge its way into the game. But so far, it looks like the vendor is going about things the right way.

athenahealth already offers the athenaOne suite, which includes an ambulatory EMR, revenue cycle management and patient engagement tools. But it seems the ambitious execs there have also decided to participate in the bare-knuckled fight for hospital bucks being duked out between Cerner, Epic, MEDITECH, McKesson and Allscripts. Considering the billions at stake, these acute care giants won’t be gentle. But as the following details suggest, athenahealth may just have enough going for it to slip into place.

Last year, athenahealth got the ball rolling when it struck a co-development deal with Boston-based Beth Israel Deaconess Medical Center to create a new inpatient system. The two organizations agreed to kick off the development work at Beth Israel’s 58-bed hospital, which is located in the nearby suburb of Needham, Mass. The deal makes particular sense given that athena corporate is located in another Boston suburb, Watertown.

To supplement its development efforts, athenahealth also picked up small-hospital EMR vendor RazorInsights and Beth Israel’s home-built webOMR EMR. athena has replaced the RazorInsights EMR with a rebuilt version of its ambulatory athenaClinicals EMR, and integrated it with the RI hospital information system, plus several ancillary systems. This hybrid system is being sold to the small-hospital market.

athenahealth has begun converting webOMR into athenaNet in partnership with the small Needham branch of Beth Israel, working with clinicians and technical staffers to better understand the inpatient care environment.

That agreement alone might have gotten the job done, but athena didn’t stop there. Last week, the vendor announced that it would be partnering with the University of Toledo Medical Center to further speed the development of its inpatient EMR. The agreement clearly builds on the vendor’s prior relationship with the University of Toledo Physicians, which picked up the athenaOne suite in late 2014.

The deal with UTMC will do more than give athenahealth another testbed and development site. This agreement with the health system, which is dumping its McKesson Horizon system by 2018, gives athenahealth a real-life win in a substantial setting. What’s more, given that the medical center is being given the chance to build things to its liking, the new acute-care EMR is unlikely to cost as much over the long-term as, say, Epic support and maintenance.

I must admit that I still see athenahealth’s plans as fairly risky. While it has significant resources, the vendor can’t match those of its big competitors. What’s more, it could lose a great deal if it endangers its strong legacy base of ambulatory users. But if any of the established ambulatory HIT firms have a shot at the bigger deals, this one does. I’m eager to see how this turns out.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Personalized and Precision Medicine are all the buzz since President Obama announced the Precision Medicine Initiative. However, after the government tragedy known as meaningful use, many are reasonably skeptical of government initiatives to improve healthcare. Plus, the rhetoric around what’s possible with precision medicine and the realities that most hospitals and doctors face every day feels like a massive disconnect.

The reality is that there’s good reason to be skeptical of precision medicine. Think about the scope of the problem. The world of health data that we live in today is 10-20 times bigger that it was even a decade ago. That’s a massive increase in the amount of data available. Plus, much of that data is unstructured data. Combine the volume of data with the accessibility (or lack therof) of that data and it’s easy to see why some are skeptical of really implementing precision medicine in their hospital today.

When you look at current EHR systems, none of them are built to enable precision medicine. First, they were built as massive billing engines and not as engines designed to improve care. Second, meaningful use has hijacked their development roadmap for years and will likely continue to hijack their development teams for years to come. Finally, there’s been so much money doing what they’re doing, what motivation do the entrenched EHR companies have to go out and do more?

The unfortunate reality of EHR systems is that they’re not built for real time availability of data analytics that provides improved care and precision, personalized medicine. Some may get there eventually, but we’re unlikely to see them get there anytime soon. I’ve heard precision medicine defined as a puzzle with 3 billion pieces. We have to start looking outside of traditional EHR companies to start solving such a complex puzzle.

The good news is that even though EHR vendors are not providing precision medicine solutions, we’re starting to see other vendors providing precision medicine solutions today. You no longer need to wait for an EHR vendor to participate.

One example of precision medicine happening today is the recently announced SAP Foundation for Health (we’ll forgive them on the somewhat confusing name). At the core of the SAP Foundation for Health is the SAP Hana engine. Unlike many EHR systems, SAP Hana was designed for real time data analysis of massive amounts of data and that includes both granular and free form data. You can see this capability first hand in the work SAP is doing with ASCO (American Society of Clinical Oncology) and their CancerLinQ project.

Dr. Clifford Hudis from CancerLinQ (Created by ASCO) described how personalized medicine to his grandfather was going around and visiting each patient. Over time that practice stopped and we started seeing patients in clinics where we generally only had one data set available to us: the clinical data that we captured ourselves on a paper chart. Unfortunately, as we moved electronic, we just recreated our paper chart world in electronic form. It’s too bad we didn’t do more during our shift to going electronic. However, that still means we have the opportunity to aggregate and analyze health data for the benefit of our patients. In some ways, we’re starting to democratize access to health data in order to enable precision medicine.

As Dr. Hudis pointed out, healthcare currently really only learns from patients who take part in clinical research trials. In other words, that only amounts to about 3% of adult patients who contribute to our learning. This limits our view since most clinical research trials have a biased sample which aren’t representative of the general population. How can we create personalized medicine if we only have data on 3% of the patient population? This is the problem CancerLinQ and SAP Foundation for Health are working to solve. Can they create a platform that learns from every patient?

ASCO together with SAP’s Foundation for Health is working to aggregate and analyze data across cancer patients regardless of whether they’re part of a clinical research study or not. In the past, Dr. Hudis pointed out that cancer tracking use to track cancer populations with simple groups like “small cell cancer” versus “non-small cell cancer.” That was a start, but had limited precision when trying to treat a patient. With this relatively new world of genomics, ASCO can now identify, track, and compare a patient’s cancer by specific genomic alterations. This is a fantastic development since tumors generally contain changed DNA. We can now use these DNA abnormalities to classify and track cancer patients in a much more precise way than we’ve done in the past.

This platform enables oncologists the opportunity to see real time information about their patient that’s personalized to the patients own genetic abnormalities. Instead of calling around to their network of oncologist friends, Cancer LinQ provides real time access to other patient populations with similar genetic abnormalities and could give them insight into what treatments are working for similar patients. This can also provide benchmarking for oncologists to see how they compare against their colleagues. Plus, it can show real time data to an oncologist so they can know how thorough and consistent they are with their patient population. Instead of working in a bubble, the oncologist can leverage the network of data to provide true precision medicine for their patients.

Another great example of precision medicine happening today is seen in the work of Carlos Bustamante, Professor of Genetics and Stanford University School of Medicine. Carlos is using SAP Foundation for Health to quickly identify genetic abnormalities in high performing athletes. Rather than recount the stories of Carlos’ work here, I’ll just link to this video where Carlos talks about the amazing insights they’ve found from studying the genomic abnormalties of high performing athletes. I love that his precision medicine work with high performing athletes has significant potential benefits for every patient.

Carlos is spot on in the video linked above when he says that the drop in genomic sequencing costs would be like taking a $400,000 Ferrari and now selling it for 10 cents. What originally took $13 billion and years of effort to sequence the first genome now takes $1500 and a few days. Access to every patient’s genome is going to change the types of drugs we develop, the treatment options we provide patients, our choice of drugs to treat a patient, and much much more. You can see that first hand in the work that ASCO and Stanford University School of Medicine are doing. Is there any more personalized medicine than the human genome?

Of course, the genome is just one of the many factors we’re seeing in the precision medicine revolution. We can’t forget about other variables that impact a patient’s health like environmental, behavioral, patient preference, and much more. We really are looking at a multi-billion piece puzzle and we’re just getting started. Remember that healthcare is not linear, but we’ve been treating it like it is for years. Healthcare is a complex matrices of challenges and we need our technology solutions to reflect that fact.

I see a beautiful future for precision medicine that’s already begun and builds into the future. We’re developing and targeting new drugs, devices and services that work for populations and individuals. We’re seeing new open, secure platforms that provide real-time flexible R&D analysis, genomics and other “omics” disciplines, patient cohort building and analysis, patient trial matching, and extended care collaboration solutions.

Data by itself is not valuable. However, the right engine on top of the right data is changing how we look at healthcare. We’re getting a much more precise view of each individual patient. Where have you seen precision medicine starting to take hold? What precision medicine solutions are you using in your organization?

Also, check out this infographic which looks at SAP’s view of precision medicine:

SAP is uniquely positioned to help advance personalized medicine. The SAP Foundation for Health is built on the SAP Hana platform which provides scalable cloud analytics solutions across the spectrum of healthcare. SAP is a sponsor of Influential Networks of which Healthcare Scene is a member.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’ve long been hearing those people talk about the cloud. Most famously, Jonathan Bush has been beating the drum of the power of the cloud and how the cloud EHR vendors are going to take down their dinosaur client server counterparts. In the hospital world that has yet to happen for EHR software, but the cloud has still become a major part of every healthcare IT organization.

When we look at our personal lives, we all have data stored in the cloud. The cloud is a major part of most of our lives. I know I try to store nothing locally and run pretty much my entire business and personal life in the cloud. I had to recently replace my cell phone. Turns out that the change didn’t matter at all since everything I did was in the cloud. I literally didn’t even know the number of my cell phone. I just got the new phone, logged into the cloud and everything started to sync up (I did have to log in to a bunch of apps). It was beautiful.

In the latest movements towards the cloud, I’ve seen a lot of people talking about healthcare analytics heading to the cloud. It begs the question, “Will the cloud win out in the healthcare analytics space?”

I think the biggest naysayers to cloud analytics are those who say that they aren’t planning to move all their data to the cloud and they’re not comfortable with all their EHR data in the cloud so they don’t see how cloud analytics will work for them. (Side Note: I always love how we claim privacy and security when we don’t want to do something, but we don’t actually do something to ensure the privacy and security of our data.)

No doubt opinions like this will slow the adoption of cloud analytics. Most vendors I know are going to offer either option for the forseeable future. However, there are some new technologies which leave your data in place, but can leverage the cloud to access the data as needed. I first saw this with SAP, but there are probably others that are doing it too. I think technologies like this will change many people’s view of using the cloud to handle their analytics.

On a much larger scale, I don’t think health care will have a choice but to use the cloud. I don’t see every health care organization building their own private cloud in order to do all of the genomic medicine which is starting to come. I don’t see every health care organization getting the benchmarking and “grand rounds” style of data that analytics providers can provide across disparate organizations. I don’t see most organizations being able to afford to build their own analytics engine on site.

I could keep going on, but the way health care analytics is going I’m not sure that hospitals will have any choice but to embrace cloud analytics. I know this leaves many hospital CIOs uncomfortable. However, burying your head in the sand and acting like it’s not going to happen won’t make you more comfortable. Denial isn’t a good strategy. The best way to be comfortable with it and ensure that healthcare analytics clouds are safe, private and secure is for hospital organizations to make a real investment of time into what’s going on.

What do you think? Is the future of analytics at hospitals going to be in the cloud?

David is a global digital healthcare leader that is focusing on the next era of healthcare IT. Most recently David served as the CIO at an academic medical center where he was responsible for all technology related to the three missions of education, research and patient care. David has worked for various healthcare providers ranging from academic medical centers, non-profit, and the for-profit sectors. Subscribe to David's latest CXO Scene posts here.

The top news last week was from Quality Systems Inc., which owns physician software vendor NextGen Healthcare Information Systems. The news was that NextGen will acquire HealthFusion Holdings, another ambulatory vendor, for $165 million (NextGen also sold their hospital division to QuadraMed the week before). As healthcare systems are consolidating, we are also seeing the consolidation happen on the vendor side and the payer side. The shrinking healthcare profit margin has an effect on the entire industry.

What is next for the ambulatory space?

Physician Groups Joining Health Systems

As we move towards creating a clinical integrated network, the number of physician groups and independent physicians will also decrease where the majority will join an ACO or become an employee for the health systems. The decrease in medical groups and the consolidation of the medical groups will have a huge impact on the ambulatory EMR space. The industry will see a shift in the ambulatory EMR systems transition to the same EMR system that is used by the health systems, so I see a big pickup for the Cerner and Epic in the ambulatory world.

Enterprise EMR

The enterprise EMR will have bigger demands from their clients to focus on the ambulatory side. Health systems are utilizing their technology investments as part of the outreach and growth strategy so it is vital that the clinics and medical groups have a system that fits their workflow. Many industry leading healthcare organizations are becoming a software EMR vendor by providing their ambulatory system to smaller hospitals, rural clinics, and physician groups that cannot afford the technology investment of an enterprise system.

This will be a very interesting space to watch in the next year. We’ll see which players will survive and see what their strategies will be moving forward. I have been providing advisory services for many health systems in regards to their strategy for maximizing their technology investment and making it a revenue-generating tool. So I will be keeping a close eye on this space and sharing insights with you on CXO Scene going forward.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Elise Ames and Vince Ciotti has an interesting follow up post on Health System CIO that looks at Epic versus Cerner in the hospital EHR (or HIS if you prefer) market. The reality is pretty simple. Epic or Cerner are both going to be around for a long time to come. Although, I really enjoyed the 5 pieces of advice they offer at the end of the post for those buying a new car EHR (LIS):

Owner’s manual —it’s sitting right there in the glove box. For an HIS, check out the user manuals – they’re all on-line today. And unlike RFP feature checklist responses, they contain the truth…

Chat with the mechanics — they know what works well, and what breaks the most. For an HIS, ask to meet your implementation project manager before signing, and ask about their staff and (non?) experience…

Take a test drive in the model you’re buying, and on the roads you’ll be travelling. For an HIS, make unchaperoned site visits and phone calls to client hospitals of your size and using your apps…

Check out the warranty — what’s covered versus what’s not? With an HIS, ask for a boilerplate contract and request changes while you still have some competitive pressure…

Negotiate price — don’t tell the Chevy dealer he won, then ask for a discount. Tell him you may buy a Ford unless he gives you a deal… After all, no one pays list price for a mega-buck HIS, do they?

I’ve heard of many of these suggestions before. However, the first one was one I hadn’t heard before. It’s a great idea and is the beauty of the internet. I’m also surprised by those that don’t do “unchaperoned” visits to current users of an EHR. Yes, it’s one thing to go to a reference site for an EHR. That’s a good thing as well, but you’ll get more value visiting one that isn’t a reference site per se.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Everybody likes to talk about the promise of big data, but managing it is another story. Taming big data will take new strategies and new IT skills, neither of which are a no-brainer, according to new research by the BPI Network.

While BPI Network has identified seven big data pain points, I’d argue that they boil down to just a few key issues:

* Data storage and management: While providers may prefer to host their massive data stores in-house, this approach is beginning to wear out, at least as the only strategy in town. Over time, hospitals have begun moving to cloud-based solutions, at least in hybrid models offloading some of their data. As they cautiously explore outsourcing some of their data management and storage, meanwhile, they have to make sure that they have security locked down well enough to comply with HIPAA and repel hackers.

* Staffing: Health IT leaders may need to look for a new breed of IT hire, as the skills associated with running datacenters have shifted to the application level rather than data transmission and security levels. And this has changed hiring patterns in many IT shops. When BPI queried IT leaders, 41% said they’d be looking for application development pros, compared with 24% seeking security skills. Ultimately, health IT departments will need staffers with a different mindset than those who maintained datasets over the long term, as these days providers need IT teams that solve emerging problems.

* Data and application availability: Health IT execs may finally be comfortable moving at least some of their data into the cloud, probably because they’ve come to believe that their cloud vendor offers good enough security to meet regulatory requirements. But that’s only a part of what they need to consider. Whether their data is based in the cloud or in a data center, health IT departments need to be sure they can offer high data availability, even if a datacenter is destroyed. What’s more, they also need to offer very high availability to EMRs and other clinical data-wrangling apps, something that gets even more complicated if the app is hosted in the cloud.

Now, the reality is that these problems aren’t big issues for every provider just yet. In fact, according to an analysis by KPMG, only 10% of providers are currently using big data to its fullest potential. The 271 healthcare professionals surveyed by KPMG said that there were several major barriers to leveraging big data in their organization, including having unstandardized data in silos (37%), lacking the right technology infrastructure (17%) and failing to have data and analytics experts on board (15%). Perhaps due to these roadblocks, a full 21% of healthcare respondents had no data analytics initiatives in place yet, though they were at the planning stages.

Still, it’s good to look at the obstacles health IT departments will face when they do take on more advanced data management and analytics efforts. After all, while ensuring high data and app availability, stocking the IT department with the right skillsets and implementing a wise data management strategy aren’t trivial, they’re doable for CIOs that plan ahead. And it’s not as if health leaders have a choice. Going from maintaining an enterprise data warehouse to leveraging health data analytics may be challenging, but it’s critical to make it happen.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I don’t know about you, readers, but I found the following data to be rather surprising. According to a couple of new market research reports summarized by Healthcare IT News, U.S. providers continue to be eager EMR buyers, despite the decreasing flow of Meaningful Use incentive dollars.

On the surface, it looks like the U.S. EMR market is pretty saturated. In fact, a recent CMS survey found that more than 80% of U.S. doctors have used EMRs, spurred almost entirely by the carrot of incentive payments and coming penalties. CMS had made $30 billion in MU incentive payments as of March 2015. (Whether they truly got what they paid for is another story.)

But according to Kalorama Information, there’s still enough business to support more than 400 vendors. Though the research house expects to see vendor M&A shrink the list, analysts contend that there’s still room for new entrants in the EMR space. (Though they rightfully note that smaller vendors may not have the capital to clear the hurdles to certification, which could be a growth-killer.)

Kalorama found that EMR sales grew 10% between 2012 and 2014, driven by medical groups doing system upgrades and hospitals and physician groups buying new systems, and predicts that the U.S. EMR market will climb to $35.2 billion by 2019. Hospital EMR upgrades should move more quickly than physician practice EMR upgrades, Kalorama suggests.

Another research report suggests that the reason providers are still buying EMRs may be a preference for a different technical model. Eighty-three percent of 5,700 small and solo-practitioner medical practices reported that they are fond of cloud-based EMRs, according to Black Book Rankings.

In fact, practices seem to have fallen in love with Web-based EMRs, with 81% of practices telling Black Book that they were happy with implementation, updates, usability and ability to customize their system, according to the Q2 2015 survey. Only 13% of doctor felt their EMRs met or exceeded expectations in 2012, when cloud-based EMRs were less common.

Now, neither research firm seems to have spelled out how practices and hospitals are going to pay for all of this next-generation EMR hotness, so we might look back at the current wave of investment as the time providers got in over their head again. Even a well-capitalized, profitable health system can be brought to its knees by the cost of a major EMR upgrade, after all.

But particularly if you’re a hospital EMR vendor, it looks like news from the demand front is better than you might have expected.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As we’ve reported in the past, hospitals are throwing their weight behind the use of wearables at a growing clip. Perhaps the most recent major deal connecting hospital EMRs with wearables data came late last month, when Cedars-Sinai Medical Center announced that it would be running Apple’s HealthKit platform. Cedars-Sinai, one of many leading hospitals piloting this technology, is building an architecture that will ultimately tie 80,000 patients to its Epic system via HealthKit.

But it’s not just software vendors that are jumping into the wearables data market with both feet. No, as important as the marriage of Epic and HealthKit will be to the future of wearables data, the increasing participation of medical device giants in this market is perhaps even more so.

Sure, when fitness bands and health tracking smartphone apps first came onto the market, they were created by smaller firms with a vision, such as the inventors who scored so impressively when they crowdfunded the Pebble smartwatch. (As is now legendary, Pebble scooped up more than $20M in Kickstarter funding despite shooting for only $500,000.)

The time is coming rapidly, however, when hospitals and doctors will want medical-grade data from monitoring devices. Fairly or not, I’ve heard many a clinician dismiss the current generation of wearables — smartwatches, health apps and fitness monitoring bands alike — as little more than toys. In other words, while many hospitals are willing to pilot-test HealthKit and other tools that gather wearables data, eventually that data will have to be gathered by sophisticated tools to meet the clinical demands over the long-term.

Thus, it’s no surprise that medical device manufacturing giants like Philips are positioning themselves to leapfrog over existing wearables makers. Why else would Jeroen Tas, CEO of Philips’ healthcare informatics solutions, make a big point of citing the healthcare benefits of wearables over time?

In a recent interview, Tas told the Times of Indiathat the use of wearables combined with cloud-based monitoring approaches are cutting hospital admissions and care costs sharply. In one case, Tas noted, digital monitoring of heart failure patients by six Dutch hospitals over a four-year period led to a 57% cut in the number of nursing days, 52% decrease in hospital admissions and an average 26% savings in cost of care per patient.

In an effort to foster similar results for other hospitals, Philips is building an open digital platform capable of linking to a wide range of wearables, feeds doctors information on their patients, connects patients, relatives and doctors and enables high-end analytics. That puts it in competition, to one degree or another, with Microsoft, Qualcomm, Samsung, Google and Apple, just for starters.

But that’s not the fun part. When things will get really interesting is when Philips, and fellow giants GE Healthcare and Siemens, start creating devices that doctors and hospitals will see as delivering medical grade data, offering secure data transmission and integrating intelligently with data produced by other hospital medical devices.

While it’s hard to imagine Apple moving in that direction, Siemens must do so, and it will, without a doubt. I look forward to the transformation of the whole wearables “thing” from some high-end experimentation to a firmly-welded approach built by medical device leaders. When Siemens and its colleagues admit that they have to own this market, everything about digital health and remote monitoring will change.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Apple caught a lead in the patient health data game early on, snagging high-profile Ochsner Health System as its first customer in October of last year. And HealthKit has continued to see success. A Reuters story reported in February that 14 of 23 top U.S. hospitals contacted by the news organization had rolled out a pilot program testing the platform. In other words, while it has formidable competition, Apple seems to have already become the platform of choice for experimenting with patient generated data.

It has to have helped that HealthKit was already set to connect with a wide range of consumer health tracking apps. Within months of its summer 2014 launch, Apple could boast a family of more than 60 apps that connected to the platform, including Withings app HealthMate, Weight Watchers Mobile, a Panera Bread app allowing users to plan meals at the store, a Mayo Clinic app, Epic’s MyChart portal app and more.

But Apple’s competitors in the consumer health space aren’t going to give up without a fight. With the wearables market reaching 21% of consumers, fellow behemoths like Samsung, Google and Microsoft will continue to challenge Apple for the patient-generated data crown.

Microsoft, for example, has launched a collection of wearables devices — including a fitness-tracking wristband, mobile health app and cloud-based health data platform called Microsoft Health. In Microsoft’s architecture, users store health and fitness data generated by wearables, which is, in turn collected by the Health app. And remember Microsoft’s HealthVault PHR? It finds new life here, as another place for patients to store the data they personally generate.

Google also announced its a fitness and health tracking platform last summer, dubbed Google Fit. Google Fit is an open platform offering the platform SDK freely to developers. At launch, its partners included Nike+, Adidas, Motorola, Runkeeper and HTC.

Samsung, for its part, has positioned itself in more of a support role to the wearables revolution. Last May it introduced the Samsung Simband, a reference architecture for wearables. It also released open health data cloud platform SAMI (Samsung Architecture for Multimodal Interactions), which takes data from multiple sources and drills down on the data to analyze the health status of individual users.

But despite the massive firepower behind Apple’s competitors, Apple seems to have slipped ahead and taken the marketing high ground. Expect to see lots of hospitals announce that HealthKit is their patient-generated data platform of choice over the next few years. It seems like Apple is doing the right thing at the right time.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Recently, consulting giant Deloitte announced a new program, named “Evergreen,” designed to cut down the cost of implementing and operating hospital EHRs. Unfortunately, much of the Evergreen coverage in the health IT trade press was vague or downright wrong, as it suggested that Deloitte was actually going into the EHR business itself. The key point Deloitte sought to make — that it could implement and operate EHRs for 20% to 30% less than hospitals — did come across, but the rest was a bit jumbled.

Having spoken to Mitch Morris, global healthcare leader for Deloitte Consulting LLP, I can clarify much of what was confusing about the Evergreen announcement and subsequent coverage. Here’s some key points I took away from my chat with Morris:

Evergreen is a suite of services, not a product: Though some HIT editors seem to have been confused by this, Evergreen isn’t an EHR offering itself. It’s a set of EHR implementation and operation services provided by Deloitte Consultants. Evergreen also includes a financing scheme allowing hospitals and health systems to obtain a new EHR by making a series of equal payments to Deloitte over five to seven years. (“It’s like leasing a car,” Morris noted.) This allows hospitals to get into the EHR without making an enormous upfront capital investment over the first 18 months.

Evergreen is only offered in tandem with an Epic purchase: The Evergreen program arose from what Deloitte learned after doing a great deal of work with Epic EHRs, including the famous multi-billion install at Kaiser Permanente and an extensive rollout for large hospital system Catholic Health Initiatives. So at the outset, the program is only available to hospitals that want to go with Epic. Deloitte is considering other EHR vendors for Evergreen partnership but has made no decisions as to which it might add to the program.

Both onshore and offshore services are available through Evergreen: One might assume that Deloitte is offering lower implementation and operation costs by offshoring all of the work. Not so, Morris says. While Deloitte does offer services based in India and Ireland, it also taps U.S. operations as needed. Clients can go with offshore labor, onshore labor or a mix of services drawing on both.

This is a new application services management offering for Deloitte: While the consulting giant has been managing Oracle and SAP installations for clients for some time, managing EHR platforms is a new part of its business, Morris notes.

According to Morris, Deloitte expects Evergreen customers to include not only health systems and hospitals that want to switch EHRs system-wide, but also those which have done some acquisitions and want to put all of their facilities on the same platform. “It’s expensive for a health system to maintain two or three brands, but they often can’t afford the upfront capital costs of putting every hospital on the same EHR,” he said. “We smooth out the costs so they can just make a payment every month.”

This could certainly be a big score for Epic, which is likely to scoop up more of the EHR-switching systems if Deloitte helps the systems cope with the costs. And Deloitte is likely to get many takers. Let’s see, though, whether it can actually follow through on the savings it promises. That could change the EHR game as we know it.